Client Forms

Client Forms

If you are new, please print out and fill out these intake forms to bring with you to our first session. If you don’t have access to a printer, these forms can also be filled out during the first session.

Client Intake Form

HIPAA Notice

Emergency Services Form

Credit Card on File

Informed Consent to Treat a Minor (as needed only)

Release of Information (as needed only)

Informed Consent for Teletherapy

Teletherapy Session Guidelines

Send a Message

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.